Immune | August 8, 2017 | Author: Naturopath
Multiple sclerosis (MS) is an unpredictable disease that causes a disruption to the flow of information within the brain, and from the brain to the body. No one knows what causes multiple sclerosis and managing symptoms and flare-ups is notoriously tricky. But there have recently been huge research breakthroughs about the connection between MS, genetics, infection, gut health, and natural therapies.
In MS, the body's immune system mounts an abnormal response against the central nervous system - the brain, spinal cord and optic nerves - where it attacks nerve fibres and myelin (a fatty insulation that covers nerve fibres). Damaged myelin creates multiple patches of sclerosis (scar tissue) which inhibit or disturb nerve impulses travelling to and from the brain. This interruption to nerve signals causes a wide variety of symptoms.
The most common early symptoms of MS are:
Further symptoms depend on which areas of the nervous system are affected. For example, if areas of motor control are affected, then primarily symptoms may include muscular spasm, weakness, poor co-ordination and balance. Other symptoms include:
It can seem that symptoms get better and worse randomly. People with MS typically experience 1 exacerbation of symptoms every 2 years and progression of the disease is highly individual.
In autoimmune conditions, the body's immune system attacks certain antigens present on cells within particular organs or tissues within the body. In MS, the immune system mounts a response against the central nervous system, but it is still unknown why the immune cells attack their targets. Because antigens haven't been identified, MS is considered an “immune-mediated disease” rather than “autoimmune”.
Research on multiple sclerosis has been accelerating in recent years, but the cause is still unknown. It's believed that genetic susceptibility is triggered by an environmental factor – or a combination of environmental factors that occur together. These could include viral infections, poor nutrition, age and gender, and exposure to pollutants. These environmental factors also appear to have a huge impact on the progression of the disease and severity of symptoms.
The latest research findings focus on the connection between infection, immune system activation, inflammation, and gut health:
It's been known for some time that viral infections may be a trigger in the activation of immune-mediated conditions in genetically susceptible people. Researchers are getting closer to identifying which viruses could trigger MS and recent studies have suggested that the most likely culprits are Epstein Barr virus, human herpes virus-6 and varicella-zoster virus .
Bacteria may also play a role as a trigger, with Streptococcus infections recently being linked to MS activation .
When MS is “triggered” by a virus or other environmental factors, immune cells begin to attack the nervous system. Animal studies have shown that pro-inflammatory immune cells, specifically Th17 cells, are the first to infiltrate the central nervous system once MS has been triggered . Why and where these pro-inflammatory cells become activated is still unknown, but new research is pointing straight to the gastrointestinal system...
A monumental study recently showed that people with MS had higher levels of pro-inflammatory immune cells (specifically Th17 cells) within their gut than those without MS.
This makes sense since Th17 cells are generally higher everywhere in people with MS. But the reachers found that the level of Th17 cells in the patients' gastrointestinal system was directly related to the level of harmful gut bugs also found there.
This means that the types of bacteria in the gut may affect the number and quality of immune cells that are activated there – including the activation of pro-inflammatory Th17 cells .
Even more detail came from the study, showing that patients with severe symptoms and greater progression of MS had more inflammatory immune cells and harmful bacteria in their gut than patients with fewer symptoms . This means that a healthy gut may play a role in controlling symptoms and progression of MS.
Patients with higher disease activity and high levels of Th17 cells also had high levels of Streptococcus mitis and Streptococcus oralis in their large intestines. Research has shown that Streptococcus strains may be related to MS, and it's now speculated that these strains may promote the activation of pro-inflammatory Th17 cells .
Our understanding of the link between autoimmune, neurological and inflammatory conditions is growing stronger. To make it simple: in MS, bad gut bacteria leads to Th17 cells which give rise to inflammation and attack the immune system. Healthy gut bugs may help to keep immune cells in line and reduce inflammation.
It's generally accepted that nutrition is one environmental factor involved in the onset and progression of multiple sclerosis, though the specifics remain largely understudied .
But a recent study clearly showed that MS patients who avoided sugar and red meat while eating plenty of fruits, vegetables, legumes and whole grains had less disability, depression, and fatigue, and experienced better cognition, eyesight and mobility .
This makes a lot of sense, given that a high-fibre diet is a great way to support healthy gut bacteria and reduce inflammation.
A recent pilot study of 41 participants examined whether supplementation of a potent antioxidant, alpha-lipoic acid, could reduce the rate of atrophy in MS over a two-year period. The researchers showed that a daily dose of 1.2g of lipoic acid for two years significantly reduced the rate of brain tissue loss up to 68%, compared to the participants receiving placebo . These powerful effects are likely due to lipoic acid's role as an antioxidant – it acts as a free radical scavenger, chelates metal ions, regenerates glutathione, and participates in repair of cells that have been damaged by oxidation. Because it is a fat-soluble antioxidant, it is able to act within brain tissue and is one of a few molecules that can cross the blood brain barrier and stabilise it, preventing Th17 pro-inflammatory immune cells from crossing into the central nervous system.
Given the link between gastrointestinal health and immune cell activation, it makes sense to support the gut with beneficial bacteria from a good quality probiotic. A recent placebo-controlled study showed that taking a probiotic for 12 weeks improved symptoms and blood work in people with MS . Certain strains may be more effective than others depending on your individual symptoms and circumstances, so speak to a nutritionist or naturopath to get the right probiotic for you.
Vitamin D deficiency has long been linked to a risk of developing MS , and supplementation may have a place in reducing flare-ups of symptoms.
But a recent study of 415 MS-patients showed that blood levels of vitamin D were directly associated with seasonal expression of MS – low levels of vitamin D in the winter months occurred concurrently with flare-ups of symptoms .
Supplementing with vitamin D leading up to the colder months may help to keep symptoms under control.
Bone strength can decline during the progression of MS, and fractures are common due to poor co-ordination and frequent falls. Researchers are hopeful that supplementing with vitamin D may prevent MS-related osteoporosis, and fractures from falls. However, more isn't always better. A recent study showed that moderate doses of vitamin D (10,000IU per day) was effective, but that high doses had no significant impact on bone density in MS-patients .
Physical activity of any kind has been shown to relieve many symptoms of MS including depression and fatigue . Aquatic exercise , high intensity interval training , and yoga  have all showed positive impact on energy levels, cognition, physical mobility and mood in recent studies with MS patients.
 Virtanen, J. O. & Jacobson, S. (2012) Viruses and Multiple Sclerosis. CNS Neurol Disord Drug Targets.,11:5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758194/
 Cosorich, I., et al. (2017) High frequency of intestinal TH17 cells correlates with microbiota alterations and disease activity in multiple sclerosis. Science Advances, 3:7. http://advances.sciencemag.org/content/3/7/e1700492.full
 Riccio, P. (2011) The molecular basis of nutritional intervention in multiple sclerosis: A narrative review. Complementary Therapies in Medicine, 19:4. http://www.sciencedirect.com/science/article/pii/S0965229911000860
 Fitzgerald, K., et al. (2017) Diet Quality Scores and Disability Status in People with Multiple Sclerosis. Presentation: Annual Meeting of the Consortum of Multiple Sclerosis Centers. https://cmsc.confex.com/cmsc/2017/webprogram/Paper5105.html
 Spain, R., et al. (2017) Lipoic acid in secondary progressive MS. Neuro Neuroimmunol Neuroinflamm., 4:5. http://nn.neurology.org/content/4/5/e374.full
 Kouchaki, E., et al. (2016) Clinical and metabolic response to probiotic supplementation in patients with multiple sclerosis: A randomized, double-blind, placebo-controlled trial. Clin Nut., S0261 – S5641:16. https://www.ncbi.nlm.nih.gov/pubmed/27669638
 Gianfrancesco, M. A., et al. (2017) Evidence for a causal relationship between low vitamin D, high BMI, and pediatric-onset MS. Neurology, 88:17, 1623 – 1629. http://www.neurology.org/content/88/17/1623.short?sid=6c15dc5c-e827-4982-8190-7b934967a88b
 Hartl, C., et al. (2017) Seasonal variations of 25-OH vitamin D serum levels are associated with clinical disease activity in multiple sclerosis patients. J Neurol Sci., 375, 160 – 164. https://www.ncbi.nlm.nih.gov/pubmed/28320120
 Holmøy, T., et al. (2017) High dose vitamin D supplementation does not affect biochemical bone markers in multiple sclerosis – a randomized controlled trial. BMC Neurol., 17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381015/
 Shams, S., et al. (2017) Longitudinal Relationships Between Moderate and Vigorous Physical Activity, Fatigue and Depression in Pediatric MS. Presentation: Annual Meeting of the Consortum of Multiple Sclerosis Centers. https://cmsc.confex.com/cmsc/2017/webprogram/Paper5055.html
 Kargafard, M, et al. (2017) A randomized controlled trial to examine the impact of aquatic exercise training on functional capacity, balance, and perceptions of fatigue in female patients with multiple sclerosis. Arch Phys Med Rehab., 20. https://www.ncbi.nlm.nih.gov/pubmed/28735720
 Zaenker, P., et al. (2017) High-intensity interval training combined with resistance training improves physiological capacities, strength and quality of life in multiple sclerosis patients: a pilot study. Eur J Phys Rehabil Med., 5. https://www.ncbi.nlm.nih.gov/pubmed/28681596
 Cohen, E. T., et al. (2017) Feasibility and Impact of an 8-Week Integrative Yoga Program in People with Moderate Multiple Sclerosis-Related Disability: A Pilot Study. Int J MS Care., 19:1, https://www.ncbi.nlm.nih.gov/pubmed/28243184